How the Supervision, Performance Assessment, and Recognition Strategy is Improving Health Services across Uganda
Districts in Uganda faced many problems in managing medicines and health supplies. Health facilities often placed orders for medicines and health commodities without reviewing their consumption rate—how much they had been using—which led to both the expiration and stock-out of vital medicines. Medicines were also prescribed without following treatment guidelines, which when coupled with inadequate information and instructions during dispensing, left patients dangerously confused.
The US Agency for International Development (USAID)-funded, Management Sciences for Health (MSH)-led Securing Ugandans’ Right to Essential Medicines (SURE) program collaborated with the Ministry of Health’s Pharmacy Division to develop the Supervision, Performance Assessment, and Recognition Strategy (SPARS) to increase health workers’ ability to manage medicines through on-the-job training and support from a new cadre of medicines management supervisors (also referred to as MMS). What distinguishes SPARS from previous supervision strategies is that the medicines management supervisors visit facilities regularly and measure progress using a standardized assessment tool with 25 indicators. The recognition aspect of the strategy is a reward scheme for both medicines management supervisors and health facilities that meet targets— medicines management supervisors rewards range from t-shirts to netbooks, while facilities can receive stock books, dispensing trays, shelves, or community recognition events.
Our system for stock management has improved. We update our stock cards regularly and carry out a physical count every month, which we never used to do in the past. Our orders are based on consumption and we keep enough stock to last up to the next delivery.
—Lebu Akim, Stores Assistant, Koboko Health Center IV, Uganda
Medicines management supervisors are district employees who are expected to spend an estimated five days a month on SPARS, in addition to their other duties; incorporating the program into the existing human resource structure helps assure sustainability. Medicines management supervisors are trained in stock and storage management, ordering, reporting, dispensing, prescribing, and how to measure performance in these areas. In addition, they receive instruction in mentoring and communication. Medicines management supervisors collect facility performance data by reviewing records during supervisory visits, observing practices, and talking to patients. They also answer questions and provide encouragement to the facility staff. Medicines management supervisors learn how to accurately record their data in netbooks and send it via Internet.
By using a standard performance assessment, SURE can analyze the data and produce district-level reports that help the MMS identify and target areas of poor performance, allow facility staff to compare their performance to others’ and show progress over time, and give the District Health Officer an idea of how well facilities are doing,
This is the first time we are getting a report on general performance of our facilities. After reading through the report, I went and visited the best two performing facilities and the worst performing facility in Masaka district. I noticed a very big difference. We shall from today on participate in assessment of these facilities by going out together with the supervision teams.
—Dr. Stuart Musisi, District Health Officer, Masaka District, Uganda
SPARS has led to significant improvement in health facility practices in all the five indicator categories as illustrated in figure below. Overall, the average increase in health facilities’ scores is 70 percent from visit one to five.
As a result of these positive changes, the Uganda Ministry of Health adopted SPARS as a national strategy and it is now being implemented in 106 out of the 112 districts in Uganda. The SURE program indirectly works in 59 districts and has provided support to 11 partners who are rolling out the strategy in the remaining districts. SURE program support includes training MMS and sharing expertise and tools for SPARS implementation.
Introduction of the SPARS tool in early 2011 increased capacity for the district in commodity management issues and ensuring that medicines and health supplies management is always on the agenda of the district health management team and district leadership. We have witnessed improved efficiencies leading to minimal wastage compared to the era of medicines expiring in districts.
—Dr. Elly Tumushabe, District Health Officer Mukono District
Updated, January 29, 2015